RAC Shield Features

 

With RAC Shield providers are enabled to target the entire Medicare RAC and Medicaid RAC audit process to address overall revenue preservation for improved financial performance.  Prepare your organization for all aspects of Medicare and Medicaid RACs by monitoring the status of the audits for all of the review programs.

RAC Shield is a real-time RAC workflow solution designed specifically to help hospitals manage key workflow processes, and comply with current RAC collection standards.  RAC Shield pulls data directly from any patient accounting system into a user friendly interface making it easy to manage deadlines, share and update information, and research details of each identified RAC account. In addition, RAC Shield utilizes advanced business intelligence and reporting capabilities to track progress, monitor efficiencies, and simplify the intricate RAC appeals process.

Technology to Manage RAC Audits and Processes

  • Creates a RAC database with all at-risk accounts from October 2007 to current
  • Enables multiple users to investigate identified RAC accounts simultaneously
  • Summarizes denial reasons and details information about overturned accounts
  • Exposes high risk in-house or recently discharged RAC patients through a comprehensive level of care analysis
  • Correlates Medicare RAC accounts with other payor accounts to isolate the areas where denials occur and to develop more effective practice patterns
  • Enables users to input and share notes in each account file
  • Mines a hospital or health system’s claims to determine what Medicare and Medicaid claims are at risk for review
  • Sets deadlines for each account and automatically schedules upcoming target dates
  • Manage tasks and responsibilities and improve communication through workflow functionality
  • Integrates work-driver metrics to track and manage time-sensitive appeal activities
  • Provides instant access to appeal status and recent RAC activity, outcome reporting, balance, and patient and transaction level details for each account
  • Prompts users with critical level of process information, such as ‘initial request,’ ‘appeal level 1,’ etc.
  • Prompts users with stage of process information, such as ‘initial request received,’ ‘submitted medical records,’ ‘judicial law judge,’ etc.
  • Complete technology solution that identifies, addresses and manages all audits, inclusive of all RAC activity
  • Tracking and trending capabilities through data collection and reporting to identify areas for process improvement

 

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